Reporting Bullying
Please utilize this form to report any incidents that may be related to bullying at Klinger Middle School.
Email address *
What is your name?
Your answer
I am a... *
What happened? *
Your answer
What was the victim's name? *
Your answer
What was the aggressor's name?
Your answer
Witness *
Who were the witnesses (names if possible)?
Your answer
If cyber, do you have any evidence (example, screenshots, photos, videos, etc.)
If you have evidence, please explain what you have.
Your answer
Was this physical, verbal, or cyber? *
Where did this occur? (if this was a cyber event, where was the post, message, etc. received). *
When did this occur? (Date and time if possible) *
Your answer
Have you told any staff at Klinger about this? If so, who?
Your answer
Please provide your phone number or email address if you would like to be contacted.
Your answer
If there is anything else that you feel is important for Kilnger staff to know about this situation or incident, please explain.
Your answer
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